Discover your Medicare eligibility and coverage options.
Table of Contents
Questions
What people are qualified for Medicare Part A coverage?
How much of my expenses will be covered by Medicare Part A?
Who can get Medicare Part B coverage?
What expenses does Medicare Part B cover?
How much of my expenses will be covered by Medicare Part B?
Who can get Medicare Part D coverage?
What is the cost of Medicare Part D?
Can I have my Medicare Part D premiums waived?
What exactly is Medicare?
When will I be able to sign up and when will my coverage begin?
What people are qualified for Medicare Part A coverage?
Anyone over the age of 65 is eligible for Medicare. Most adults over the age of 65 are eligible for free Medicare Part A coverage based on their job records or the work records of their spouse.
People over the age of 65 who do not qualify for free Medicare Part A coverage may join and pay a monthly charge for the same coverage. The premium base rate is determined by the number of labor credits obtained. If you pay for Part A hospital insurance, you must also enroll in Part B medical insurance, which has a monthly cost of its own.
How much of my expenses will be covered by Medicare Part A?
The number of days of inpatient treatment you get during a “benefit period,” or spell of sickness, determines how much Medicare Part A pays. The benefit period starts the day you are admitted to the hospital or skilled care facility as an inpatient and ends after you have been released for 60 days. If you have been in and out of the hospital or nursing facility numerous times but have not been entirely discharged for 60 days, all of your inpatient costs for that time will be calculated as part of the same benefit period.
Medicare Part A covers just a portion of a hospital payment in any given benefit period—and the requirements vary based on whether the care facility is a hospital, mental institution, or skilled nursing facility, or if care is provided at home or via a hospice.
Before Medicare would pay anything, all persons insured by Medicare Part A must pay an upfront sum. This is referred to as the hospital insurance deductible. Every January 1, the deductible is raised.
Who can get Medicare Part B coverage?
The eligibility standards for Part B medical insurance are simpler than those for Part A: If you are 65 or older, a U.S. citizen or a permanent resident who has been in the country legally for five years, you are eligible to enroll in Medicare Part B medical insurance. This is true regardless of whether you qualify for Part A hospital insurance.
More information about Medicare Part B may be found here.
What expenses does Medicare Part B cover?
Part B medical insurance is designed to cover the most basic medical treatments supplied by physicians, clinics, and labs. However, the lists of services that are and are not covered are lengthy and may not always make sense.
Making an effort to discover what is and is not covered might be beneficial, since you may gain the maximum advantages if you fit your medical treatments within the covered categories whenever feasible.
Part B insurance covers the following expenses:
mammograms, pelvic examinations, bone density tests, and PAP smears for women mammograms, pelvic exams, bone density tests, and PAP smears for men
a yearly flu shot
a one-time physical exam (referred to as a “wellness exam”) performed within six months of enrolling in Medicare Part B medical services provided by nurses, surgical assistants, or laboratory or X-ray technicians outpatient hospital treatment, such as emergency room or clinic charges, X-rays, injections, and lab work an ambulance, if required for a trip to or from a hospital or skilled nursing facility drugs or other medicine administered to you at a hospital or doctor’s office (for prescription drug benefits, consider enrolling in Medicare Part D, discussed below)
Splints, casts, prosthetic devices, body braces, cardiac pacemakers, corrective glasses after cataract surgery, glucose monitoring equipment, and diabetic therapy shoes, as well as ventilators, wheelchairs, and hospital beds, are examples of medical equipment and supplies.
a few types of oral surgery
portion of the outpatient physical and speech treatment costs
a limited number of podiatrist and optometrist services
psychologists, social workers, and childcare professionals provide some treatment and counseling
Some preventive screening checks, such as those for cancer, glaucoma, and osteoporosis, as well as diabetes and heart disease, are available, but only if your doctor believes you are at risk for them.
A chiropractor’s manual manipulation of out-of-place vertebrae Alzheimer’s-related therapies
Obesity therapies and treatments that have been scientifically validated, as well as part-time expert nursing care, physical therapy, and speech therapy delivered in the comfort of your own home.
See our articles on what Medicare Part B covers and what Medicare Part B does not cover for more information.
How much of my expenses will be covered by Medicare Part B?
When you sum up all of your medical expenditures, you’ll see that Medicare only covers around half of the total. There are three key causes for the low salary.
For starters, Medicare does not cover a variety of important medical costs, including glasses, hearing aids, dental procedures, dentures, and a variety of other pricey medical services.
Second, Medicare only pays a fraction of what it determines to be the right cost for medical services (known as the authorized charges). When Medicare certifies that a certain treatment is covered, it establishes the allowed rates for that service. Part B medical insurance typically covers just 80% of those authorized expenditures; the other 20% is your responsibility.
Third, although the allowed amount may seem acceptable to Medicare, it is often far less than what physicians actually charge. If your doctor or other medical practitioner refuses to accept Medicare charge assignment, you are personally liable for the difference, up to a specific amount.
It is worth noting that Medicare Part B now pays 100% of authorized rates rather than the normal 80% for a variety of therapies and medical providers. Home health care, clinical laboratory testing, and flu and pneumonia vaccinations are examples of these types of services.
See our post on what Medicare Part B will pay for more information.
Who can get Medicare Part D coverage?
Anyone who is eligible for Medicare Part A (whether enrolled or not) or who is presently enrolled in Medicare Part B may enroll in Medicare Part D to get assistance with prescription medication expenses. Except for persons who also get Medicaid coverage, enrollment is optional (Medi-Cal in California). If you are eligible for Medicaid, the government will automatically enroll you in a Medicare Part D plan, which will provide you with prescription medication coverage. See Medicare Part D Prescription Drug Coverage: The Fundamentals for further information. See Medicare Part D: Choosing a Prescription Drug Plan for assistance in selecting a Part D plan.
What is the cost of Medicare Part D?
Premiums, deductibles, copayments, and a coverage gap during which you must pay the entire cost of your drugs are the four categories of expenditures connected with Medicare Part D prescription drug coverage. People with low incomes may be eligible for a Social Security Administration reimbursement to help with these fees.
Part D rates vary between $10 and $100 per month (depending on the plans available in your area and on the particular plan you choose). In 2020, the maximum deductible (the amount you must pay out of pocket before Medicare will cover your prescription expenses) is $435.
You must pay 25% of the cost of your medicines once you and your plan have paid a set amount for approved generic prescription pharmaceuticals ($4,020 in 2020). When overall expenses hit a “catastrophic” threshold ($6,350 in 2020), the plan starts to pay again—and covers 95% of any further costs.
Can I have my Medicare Part D premiums waived?
Low-income Medicare recipients may be eligible for a subsidy to assist cover the costs of Part D insurance. Extra Help is the name given to this subsidy. Additionally, in certain cases, the copayment for medicines may be eliminated or lowered.
You may be eligible for a low-income Part D subsidy if you:
Aside from low-income subsidies, there are times when a Part D plan enrollee may not have to pay the standard copayment for an approved prescription. These are some examples:
There are no copayments for those who reside in a long-term care nursing home and are enrolled in both Medicare Part D and Medicaid.
Some plans waive or decrease copayments for certain medications, especially generic ones, in order to entice individuals to join that plan. However, the plan has the right to modify this copayment waiver at any time.
Pharmacies may waive copayments for any medicine for any enrollee with a low-income subsidy. However, the waiver is not automatic; you must request it.
What exactly is Medicare?
Medicare is a federal government program that assists the elderly and certain handicapped persons with the payment of medical bills and prescription medication expenditures. Part A, Part B, Part C, and Part D are the four sections of the program.
Part A is known as hospital insurance, and it covers the majority of hospital stay expenses as well as certain follow-up charges.
Part B, medical insurance, covers for certain doctor visits and outpatient medical services.
Part C is sometimes referred to as Medicare Advantage. Private insurers and Medicare Managed Care Plans manage it (such as an HMO that provides Medicare-covered services as well as other coverage).
Some prescription medication expenditures are covered under Part D.
When will I be able to sign up and when will my coverage begin?
People turning 65 have a three-month initial registration period that ends three months after their 65th birthday. If you don’t sign up within that time, you’ll have to wait until the next general enrollment or special enrollment session (if you delayed signing up because you had an employer group health plan). The start dates of your coverage are determined on the sort of period you signed up for.